In pre-eclampsia the platelet count is not a static number. It can fall by tens of thousands over a few hours in a woman who is deteriorating, and the count that sits at the top of the chart is often the one taken at admission, before the deterioration that brought her to theatre.
Before siting a neuraxial block in a woman with pre-eclampsia, look at the time stamp on the full blood count, not just the value. If it is more than a few hours old and anything about her has changed — the blood pressure, the headache, the epigastric pain, the urine output — repeat it. The same applies to the liver panel, which tends to move with it.
This costs one tube of blood and a short wait, and it is the difference between a decision made on current information and one made on a number that has been overtaken.
- Check the time the sample was drawn, not only the result.
- Repeat the count if the clinical picture has changed since it was taken.
- Send liver enzymes on the same sample — they move together and both inform the decision.
- Record the count and its time in the anaesthetic note, so the next person knows what you acted on.
- Have a plan for what you will do at each threshold before you send the sample, so a low result does not cause a second delay.
Why it matters
A safe-looking platelet count can be several hours out of date in exactly the woman whose count is falling fastest.
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